548 Endodontics

19
The ProTaper Technique
Shaping the Future of Endodontics
CLIFFORD J. RUDDLE

There have been signicant advancements in the development of NiTi rotary instruments in recent years.
This evolution is driven by market demand and the
continuous improvement in the manufacturing process. Dentists have increasingly identied the features
they deem essential on the endless journey towards a
more perfect le. These features include exibility, efciency, safety, and simplicity. The ProTaper system
has been designed to provide these features; consequently, its entrance into the marketplace has had a
profound effect.
The ProTaper NiTi les (Dentsply Maillefer;
Ballaigues, Switzerland) represent a revolutionary generation of instruments for shaping root canals (Fig.
19.1).14 This chapter will review the ProTaper geometries, then describe the ProTaper concepts, techniques
and nishing criteria that may be utilized to fulll the
mechanical and biological objectives for shaping canals. Learning the ProTaper concept will lead to discovery then appreciation for this six instrument set,
comprised of just three Shaping and three Finishing les (Fig. 19.2).

and their D14 maximal ute diameters approach 1.20

mm (Fig. 19.3). The Auxiliary Shaping File, termed SX,
has no identication ring on its gold-colored handle
and, with a shorter overall length of 19 mm, provides
excellent access when space is restrictive. Because SX
has a much quicker rate of taper between D1 and D9
as compared to the other ProTaper Shaping les, it is
primarily used, after S1 and S2, to optimally shape canals in coronally broken down or anatomically shorter
teeth. The SX le has a D0 diameter of 0.19 mm and a
D14 diameter approaching 1.20 mm (Fig. 19.4).

PROTAPER GEOMETRIES
The following will describe the ProTaper geometries and specic features that make these Shaping
and Finishing les remarkably unique.
The shaping les
Shaping File # 1 and Shaping File # 2, termed S1
and S2, have purple and white identication rings on
their handles, respectively. The S1 and S2 les have
D0 diameters of 0.17 mm and 0.20 mm, respectively,

Fig. 19.1. This endodontically treated mandibular

second bicuspid demonstrates a smooth owing
dilacerated preparation, apical bidity and the
ProTaper advantage (Courtesy of Dr. Fabio Gorni;
Milano, Italy).

19 - The ProTaper Technique

Progressively tapered design

A unique feature of the ProTaper Shaping les is
each instrument has multiple increasing percentage tapers over the length of its cutting blades. This
progressively tapered design serves to signicantly improve exibility, cutting efciency, and safety.3
Fortuitously, a progressively tapered design typically reduces the number of recapitulations needed to
achieve length, especially in small diameter or more
curved canals. As an example, the SX le exhibits nine increasingly larger tapers ranging from .035 to .19
between D1 and D9, and a xed .02 taper between D10
and D14. The S1 le exhibits twelve increasingly larger tapers ranging from .02 to .11 between D1 and D14.
The S2 le exhibits nine increasingly larger tapers ran-

549

ging from .04 to .115 between D1 and D14. This design

feature allows each shaping le to perform its own
crown down work. One of the benets of a progressively tapered shaping le is that each instrument engages a smaller zone of dentin which reduces torsional loads, le fatigue and the potential for breakage.6
The nishing les
Three Finishing les named F1, F2 and F3 have yellow, red and blue identication rings on their handles corresponding to D0 diameters of 0.20 mm, 0.25
mm, and 0.30 mm, respectively. Additionally, F1, F2,
and F3 have xed tapers between D1 and D3 of .07,
.08, and .09, respectively (Fig. 19.5). However, unlike

Fig. 19.2. ProTaper les represent a revolutionary progression in exibility, efciency, safety and simplicity for preparing root canals.

Fig. 19.3. S1 and S2 each have progressively larger tapers over the length of
their blades allowing each instrument to perform its own crown-down work.

Fig. 19.4. Shaper X has 9 increasingly larger tapers ranging from .035 to .19
and is used in a brushing motion to cut dentin, between D6 and D9, on the
outstroke.

Fig. 19.5. The nishing les have variable D0 diameters and tapers, and blend
the deep shape into the middle one-third of the canal.

550 Endodontics

the Shaping les, the Finishing les have decreasing

tapers from D4-D14. This design feature serves to improve exibility, reduce the potential for dangerous
taper-lock, and prevent the needless over-enlargement of the coronal two-thirds of a root canal.
Convex triangular cross-section
Another feature of the ProTaper instruments relates to their convex triangular cross-section (Figs.
19.6 A, B).
This feature decreases the rotational friction
between the blade of the le and dentin, enhances
the cutting action, and improves safety, as compared
to radial-landed instruments.3 As is true with any instrument, increasing both its D0 diameter and taper
correspondingly increases its stiffness. To improve
exibility, ProTaper Finishing les F2 and F3 have recently been machined with a reduced core, as compared to the other instruments in the series. The core is reduced by machining a small concavity within
each of the three convex sides of the triangular crosssection.

Helical angle & pitch

ProTaper les have a continuously changing helical
angle and pitch over the length of their cutting blades
(Figs. 19.7 A, B). Changing the pitch and helical angles over the active length of blades optimizes its cutting action and more effectively augers debris out of
the canal. Importantly, changing the pitch and helical
angles of a le, in conjunction with a progressively
tapered design, prevents each instrument from inadvertently screwing into the canal.10
Modied guiding tip
Another feature of the ProTaper les is each instrument has a modied guiding tip. A modied guiding tip
is created by machining off 25% of the most apical extent of each les rounded, non-cutting, and parabolicshaped tip. This design feature allows each instrument
to accurately follow a smooth reproducible glide path,
and importantly, enhances its ability to load soft tissue
and loose debris into the intrablade utes, where it can
be efciently augured out of the canal (Fig. 19.8).7

B
Fig. 19.6. A, B. The ProTaper instruments have a convex triangular cross-section which improves cutting efciency while maximizing core strength (Fig. B courtesy of Prof. Elio Berutti; Torino,
Italy).

Fig. 19.7. A, B. ProTaper les perform smoothly, efciently and safely as a result of their progressively tapered design and continuously changing pitch and helical angle (Fig. B courtesy of Prof.
Elio Berutti;Torino, Italy).

19 - The ProTaper Technique

551

The following summarizes the ProTaper rotary shaping le concepts and guidelines:
Straightline access

Fig. 19.8. ProTaper les have a modied guiding tip which enables the tip of
the le to safely follow the glide path and better auger soft tissue and loose
debris out of the canal (Courtesy of Prof. Elio Berutti; Torino, Italy).

PROTAPER CONCEPTS & GUIDELINES

There are a few basic concepts that, when followed,
will promote efcient performance and excellent safety when using NiTi rotary instruments (Fig. 19.9).
Rotary instruments should only be placed in portions
of the canal that have a conrmed, smooth and reproducible glide path.6 Further, rotary NiTi instruments
should only be used in the apical one-third of a canal
that has a known, accurate working length and is patent. Finally, when incorporating the ProTaper instruments, clinicians should follow the specic directions
for use, observe the recommended sequencing of les, and adhere to the correct range of speed and prescribed torque.

Fig. 19.9. ProTaper les were utilized in the endodontic treatment of this mandibular rst molar. Note four optimally prepared systems exhibiting multiplanar curvatures (Courtesy of Dr. Pierre Machtou; Paris, France).

The access preparation is an essential element for

successful endodontics.8 Preparing the endodontic
access cavity is a critical step in a series of procedures that potentially leads to the three-dimensional obturation of the root canal system. Access cavities should be cut so the pulpal roof, including all
overlying dentin, is removed. The size of the access
cavity is dictated by the position of the orice(s).
The axial walls are extended laterally such that the
orice(s) is just within this outline form. The internal walls are ared and smoothed to provide easy,
straightline access into the orice and the root canal
system (Fig. 19.10).
Access preparations are expanded to eliminate any
coronal interference during subsequent instrumentation. Access objectives are conrmed when all the orices can be visualized without moving the mouth mirror. Ideally, endodontic access cavities should parallel
the principle of restorative dentistry where the axial
walls of a nished preparation taper and provide
draw for a wax pattern. Cleaning and shaping potentials are dramatically improved when instruments conveniently pass through the occlusal opening, effortlessly slide down smooth axial walls and are easily inserted into a preared orice (Fig. 19.11).
Spacious access cavities are an opening for canal
preparation.9,20

Fig. 19.10. A photograph at 15x shows straightline access, divergent axial walls
and the orices just within this outline form.

552 Endodontics

Fig. 19.11. The canals of this endodontically treated mandibular rst molar were gauged and tuned, and the pack demonstrates the uniform and fully tapered shapes.

Irrigation & lubrication

No instrument should be introduced into the root
canal space until the appropriate irrigant is introduced
into the pulp chamber. The importance of irrigants,
their methods of use and their role in negotiating and
shaping canals and in cleaning the root canal system
has been described in several clinical articles.5-13
Reproducible glide path
Cleaning and shaping outcomes are signicantly improved initially utilizing stainless steel 0.02 tapered sizes 10 and 15 hand les (Dentsply Maillefer; Ballaigues,
Switzerland). Small-sized hand les are optimally utilized, in the presence of a viscous chelator, to scout any
portion of the overall length of a canal.13-15
Hand les create or conrm a smooth, reproducible
glide path before introducing any rotary NiTi instruments into this secured length of the canal.6,7 With the
onset of NiTi rotary instrumentation, the role of hand
instruments has diminished and been redened. For
many rotary le users, small hand instruments are primarily used to gather reconnaissance information, to
conrm available space, or when necessary, to create sufcient space prior to using more efcient rotary
NiTi instruments. The 10 and 15 scouter les should
not be thought of as just measuring wires, rather they
can additionally provide feedback regarding:15
1) Cross-Sectional Diameter
Scouter les immediately reveal the cross-sectional diameter of a canal and provide information

as to whether the canal is open, restricted, or signicantly calcied. Before a ProTaper rotary instrument can be safely introduced into the canal,
sufcient space must exist to passively accommodate and guide their tips. In other words, there
must be a pilot hole of circumferential dentin and
a smooth glide path for a NiTi rotary instrument to
follow. As an example, if a canal has been scouted
to within 3-4 mm of anticipated working length
with 10 and 15 hand les, then more space exists than the les numerical names suggest. Recall
the 10 and 15 hand les taper 0.02 mm/mm, have 16 mm of cutting utes and their D16 diameters
are 0.42 and 0.47 mm, respectively. Generally, these small-sized instruments will provide a sufcient
opening for the implementation of rotary instruments.
2) Coronal & radicular access
Scouter les conrm the presence or absence of
straightline coronal and radicular access. Clinicians
can observe the handle position of the smaller sized instruments to see if they are upright and paralleling the long axis of the tooth or skewed offaxis. In the instance where the roots are under the
circumferential dimensions of the clinical crown
and the le handle is upright, or ON the long axis
of the tooth, then the clinician is able to conrm
both coronal and radicular straightline access. In instances where the handle of the initial scouting instrument is OFF the long axis of the tooth, then
pre-enlargement procedures should be directed
towards uprighting the le handle (Fig. 19.12).16,21

Fig. 19.12. The handles of small hand les are frequently OFF axis in furcated
teeth due to internal triangles of dentin.

19 - The ProTaper Technique

To upright the handle of the small scouter les oftentimes requires rening and expanding the access preparation and selectively removing the triangle of dentin from the coronal one-third of the canal. This procedural distinction is critical and simplies all subsequent instrumentation procedures
while virtually eliminating many cleaning and shaping frustrations (Fig. 19.13).16,18
3) Root canal system anatomy
Scouter les can provide information regarding
root canal system anatomy. Clinicians need to appreciate the ve commonly encountered anatomical forms which include canals that merge, curve,
recurve, dilacerate or divide. Scouter les provide
information regarding the anatomy and give important feedback regarding the canals degree of
curvature, recurvature, or if there is a dilaceration
(Fig. 19.14). Further, before introducing rotary instruments, clinicians need to know if a single canal coronally subsequently divides or if two or mo-

553

re systems within a root merge along their length. It

must be recognized that certain root canals exhibit
anatomical congurations which preclude the safe
use of NiTi rotary les. In these instances, precurved manual ProTaper les afford a safe alternative,
as compared to the risk associated with using rotary
instruments (Fig. 19.15).
Working length & patency
The breakthrough to predictable shaping procedures is to have both an accurate working length and a
patent canal. Patency is performed by gently directing
small, highly exible les to the radiographic terminus (RT).20
To ensure patency, the le tip is intentionally inserted minutely through the foramen to discourage
the accumulation of debris (Fig. 19.16). Importantly,
working a small, exible le to the RT will encoura-

Fig. 19.13. Sequencing the preparation facilitates shaping canals

and cleaning root canal systems. Complete endodontic treatment is the foundation of perio-prosthetics.

Fig. 19.14. This endodontically treated mandibular bicuspid demonstrates a corkscrewing and spiraling system that has been
optimally treated.

Fig. 19.15. ProTaper hand les (Courtesy of Dentsply/Maillefer;

Ballaigues, Switzerland).

Fig. 19.16. Vital and necrotic canals are negotiated to length and
patency is established and maintained to promote the preparation objectives.

554 Endodontics

ge the elimination of dental pulp, related irritants, and

dentinal mud. Keeping the canal terminus patent discourages blocks, ledges and perforations.16,18 It is illogical to assume that passing a small le passively and
minutely through the apical foramen is going to prejudice the result or predispose to any irreversible conditions when one reects on the rich collateral circulation and healing capacity available in the attachment
apparatus. Clinicians should stop fretting over the use
of patency les and recall the well-known, often used,
and more invasive disciplines, such as endodontic surgery and dental implants.
Researchers, academicians and clinicians are well
aware that when a le is passed through the entire length of a canal and its most apical extent is observed to be at the radiographic terminus, then, in
actuality, the instrument is minutely long. Traditional
wisdom advocates that since the apical extent of a canal terminates at the cementodentinal junction (CDJ)
then working length should extend to this anatomical landmark.11 Although the CDJ exists in a non-pulpally involved tooth, its position can never be precisely located clinically as this histological landmark varies signicantly from tooth to tooth, from root to root,
and from wall to wall within each canal. Working arbitrarily short of the radiographic terminus based on
statistical averages encourages the accumulation and
retention of debris, which frequently results in apical blocks that predispose to ledges and perforations.
Working short has led to many frustrations, interappointment are-ups, unexplained failures, surgical
procedures and extractions.16,18
Electronic apex locators represent an improvement
over radiographs for more accurately identifying the
position of the foramen.22 Technological advancements in specic apex locators provide greater accuracy in length determination even in canals that contain exudates or electrolytes. It should be understood
that apex locators do not replace lms but are used
intelligently in conjunction with radiographs. When a
predictable and smooth glide path is established to
the RT and working length is conrmed, then the apical one-third of the canal can be shaped and nished
in a variety of ways.15
Directions for use
Rotary instruments should be employed in strict
accordance with their prescribed directions for use.
If any NiTi rotary instrument ceases to advance dee-

per into a canal, withdraw it, and recognize the four

factors that typically prevent the le from passively
moving in an apical direction:
1) Insufcient canal diameter. Insufcient canal diameter will prevent a rotary NiTi instrument from
passively moving deeper into the canal. Recognize
that the working end of a rotary le may be too big
or stiff to follow the anatomy or diameter of a canal. It is important to appreciate NiTi rotary instruments may not be able to follow a canal that abruptly curves, divides, or whose walls exhibit resorptive or iatrogenic defects. In smaller diameter or more curved canals, use the 10 and 15 hand les, in
conjunction with a viscous chelator. If necessary,
a few larger hand instruments may be required to
create a smooth, reproducible glide path for manual or rotary NiTi instruments to predictably follow.
2) Intracanal debris. Intracanal debris may accumulate in a canal that previously exhibited a conrmed
and reproducible glide path. To eliminate intracanal debris, after each rotary le, voluminously irrigate the root canal space, recapitulate with a # 10
le to break-up debris and move it into solution,
then re-irrigate to ush-out this loosened debris.
Use a 10 or 15 le to conrm a smooth, reproducible glide path before commencing with rotary shaping procedures.
3) Intrablade debris. Another possibility that limits the
apical movement of an instrument is the accumulation of debris within the depth between the cutting
blades. Intrablade debris tends to deactivate an instrument as it pushes the active part of the le off
the wall of the canal. In this latter case, withdraw
the instrument and clear its blades, irrigate the canal, recapitulate with a small hand le to conrm
the existence of the previously established glide
path, then re-irrigate to ush out debris.
4) Root canal anatomy. Certain systems exhibit difcult anatomical congurations that discourage or
prevent the tip of a rotary instrument to passively
and safely follow the canal (Figs. 19.17 A-D). In
these instances, irrigate and recapitulate with small
hand les to improve the diameter of the glide path
of the canal or precurve a ProTaper hand le to
bypass the anatomical impediment. It should be recognized that certain anatomical congurations, pathological defects, or iatrogenic ledges are best shaped with hand les. The ProTaper les can be precurved and used manually to follow any part of a
canal that has been negotiated and enlarged to at

19 - The ProTaper Technique

least a size 15 hand le. However, ProTaper rotary

les should not be used until there is a conrmed,
smooth, and reproducible glide path.

555

and curvature of any given canal. When the guidelines

for use are carefully followed then the ProTaper les
unique geometries afford unsurpassed safety, exibility and efciency.3,23,24

Multiple vs. single use

Motors
The two most important causes that contribute to
NiTi rotary instrument breakage are method of use
and multiple use of les. During use, any given
ProTaper le should be inspected for wear and its cutting blades frequently cleaned to optimize efciency
and reduce the potential for breakage. In the authors
opinion, all NiTi rotary instruments should be discarded after each case due to metal fatigue, loss of cutting
efciency, and the great variation in length, diameter

All the ProTaper instruments should be utilized in

a gear reduction handpiece in conjunction with a torque controlled electric motor. The motor should be set
to provide a torque of 520 g.cm and speeds ranging
from 250-300 RPM.6 Advancements in electric motors
in the years immediately ahead hold the promise to
improve clinical performance and safety when using
NiTi rotary les.

D
Fig. 19.17. A. Small hand les should be used to verify if the apical one-third of a pre-enlarged canal has either a smooth or irregular glide path. B. When small
hand les cannot easily slide along a canal, then NiTi rotary-shaping instruments should not be used. C. A graphic illustrates a pre-enlarged canal can more
readily accommodate a precurved hand le and improve the predictability of achieving length. D. A graphic illustrates a 15 le can be utilized to determine
if there is a smooth reproducible glide path to safely accommodate a rotary shaping le.

556 Endodontics

THE PROTAPER TECHNIQUE

Preparing a root canal can commence after completing straightline access to the orice(s). In teeth
exhibiting calcication, dentin can be precisely sanded away and orices more readily identied by utilizing contra-angled, parallel-walled and abrasively coated ultrasonic instruments (Fig. 19.18) (ProUltra Endo
Tips, Dentsply Maillefer; Ballaigues, Switzerland).17 In
combination, microscopes and ultrasonics have driven microsonic techniques that have improved successfully locating receded orices. Once any orice
has been located, it can be advantageously ared with
one or more gates glidden drills (Dentsply Maillefer;
Ballaigues, Switzerland). Attention to detail when -

nishing the access cavity facilitates the subsequent

shaping of a root canal (Fig. 19.19).
Scout the coronal two-thirds
The potential to consistently shape canals and clean
root canal systems is signicantly enhanced when the
coronal two-thirds of the canal is rst pre-enlarged
followed by preparing its apical one-third (Figure
19.20).15,17 The concept of rst pre-enlarging a canal
followed by nishing its apical one-third is analogous
to a crown preparation procedure in which the tooth
is rst reduced prior to nishing the margins.
When straightline access is completed, the pulp
chamber may be lled brimful with a viscous chelator. Based on the pre-operative radiographs, ISO 0.02
tapered sizes 10 and 15 hand les are measured and
precurved to match the anticipated full length and
curvature of the root canal. However, in this method
of canal preparation, these instruments are initially limited to the coronal two-thirds of a root canal. The 10
and 15 hand les are utilized within any portion of the
canal until they are loose and a smooth reproducible
glide path is conrmed (Figs. 19.21 A, B). The loose
depth of the 15 le is measured and this length transferred to the ProTaper S1 and S2 les.
Shape the coronal two-thirds

Fig. 19.18. The ProUltra ENDO 1-5 stainless steel instruments have an abrasive zirconium nitride coating to improve efciency, precision and clinical performance.

The secured portion of the canal can be optimally

pre-enlarged by rst utilizing S1 then S2. Prior to ini-

Fig. 19.19. A photo at 12x demonstrates an access cavity through a prosthetically prepared crown. Note the outline pattern, smooth axial walls, and four
orices.

Fig. 19.20. An endodontically treated maxillary rst molar demonstrates ve

treated canals and that each system exhibits various anatomical congurations.

19 - The ProTaper Technique

557

ve it into solution, then re-irrigate. Without pressure,

and in one or more passes, S1, then S2, is used in this
manner until the depth of the 15 hand le is reached
(Figs. 19.22 A, B, C).

B
Fig. 19.21. A, B. Small les conrm the presence or absence of
straightline access and reveal information regarding the diameter and anatomy of a canal.

tiating shaping procedures, the pulp chamber is lled

with a full strength solution of NaOCl. Without pressure, and in one or more passes, the ProTaper Shaping
les are allowed to passively oat into the canal and
follow the glide path. To optimize safety and efciency, the Shaping les are used, like a brush, to laterally and selectively cut dentin on the outstroke.
A brush-cutting action creates lateral space which
will facilitate the shaping les larger, stronger and
more active cutting blades to safely and progressively
move deeper into the canal. If any ProTaper le ceases to easily advance within the secured portion of a
canal, withdraw it, and recognize that intrablade debris has deactivated and pushed the instrument off the
wall of the canal. Upon removing each Shaping le,
visualize where the debris is located along its cutting
blades to better appreciate the region within the canal
that is being prepared.
Following the use of each Shaping le, irrigate, recapitulate with a 10 le to break up debris and mo-

C
Fig. 19.22. A. S1 has a D0 diameter of 0.17 mm and its modied
guiding tip easily follows a previously scouted and secured canal. B. S1 is used in a brushing motion to cut dentin, remove internal triangles of dentin in furcated teeth, and safely relocate canals away from external root concavities. C. S2 follows S1, and is
used in the same brushing motion until the depth of the 15 hand
le is reached.

558 Endodontics

Scout the apical one-third

When the coronal two-thirds of the canal is shaped,
then attention can focus on apical one-third procedures. With the pulp chamber lled brimful with a viscous chelator, the apical one-third of the canal is fully negotiated, working length established and paten-

cy conrmed (Fig. 19.23).15 When the apical one-third

of the canal has been enlarged to at least the size of a
15 hand le, then a decision must be made between
whether to nish the apical one-third with rotary or
hand instruments. If a new and straight 15 le can
gently slide and passively glide to length, then rotary instruments will follow this conrmed and reproducible glide path.7,15 However, certain canals exhibit
anatomical challenges that necessitate a reciprocating
handle motion in order to move precurved 10 and 15
les to length. When there is an irregular glide path
then the apical one-third of a canal may be advantageously nished with precurved manual ProTaper instruments (Figs. 19.24 A, B and 19.25 A, B).
Shape the apical one-third

Fig. 19.23. Following pre-enlargement procedures and working

length conrmation, the 10 le is gently moved through the foramen to conrm, then maintain, patency.

When the apical one-third of the canal has been secured, then the pulp chamber is lled brimful with
NaOCl. The ProTaper sequence is to carry the S1, then
the S2, to the full working length. As previously described, oat, follow and brush as previously descri-

B
Fig. 19.24. A. A working lm of a mandibular second molar demonstrates a 10 le following a 180 curvature and the packed
MB and abruptly recurved ML systems. B. The post-treatment
lm conrms the mechanical objectives for shaping the root canals were achieved.

Fig. 19.25. A. An endodontically treated maxillary rst bicuspid

exhibits branching systems that terminate into three apical portals of exit. B. An endodontically treated mandibular second bicuspid demonstrates a single straightforward canal that divides
deep into three apical portals of exit.

19 - The ProTaper Technique

bed until the terminus of the canal is reached. S1, then

S2, will typically move to length in one or more passes
depending on the length, diameter and curvature of
the canal (Figs. 19.26 A, B). Following each ProTaper
le, irrigate, recapitulate with a 10 le, then re-irrigate. After using the Shaping les, particularly in more curved canals, working length should be reconrmed, as a more direct path to the terminus has been
established. At this stage of treatment, the preparation
can be nished using one or more of the ProTaper
Finishing les in a non-brushing manner. The F1 is
selected and passively allowed to move deeper into
the canal, in one or more passes, until the terminus is
reached (Fig. 19.27). When the F1 achieves length, the
instrument is removed, its apical utes are inspected
and if they are loaded with dentin, then visual evidence conrms this instrument has carved its shape in the

559

apical one-third of the canal. Following the use of F1,

ood the canal with irrigant, recapitulate and conrm
patency, then re-irrigate to liberate debris from the canal.
ProTaper nishing criteria
Following the use of the 20/.07 F1, the ProTaper
Finishing Criteria is to gauge the size of the foramen
with a 20/.02 tapered hand le to determine if this instrument is snug or loose at length (Fig. 19.28). If the
20 hand le is snug at length then the canal is fully shaped and, if irrigation protocols have been followed, ready to pack. Following the use of F1, if the
20 hand le is loose at length, then gauge the size of
the foramen with a 25/.02 tapered hand le. If the 25

Fig. 19.27. The exible F1 smoothly carves the deep shape and
blends this region into the middle one-third of the canal.

B
Fig. 19.26. A. S1 easily follows a canal that has a conrmed, smooth
and reproducible glide path. B. S2 is designed to perform its own
crown-down work and carries another wave of shaping deeper
into the canal.
Fig. 19.28. Following the use of the 20/.07 F1 rotary le to length,
the foramen is gauged using a 20/.02 hand le.

560 Endodontics

le is snug at length, then the canal is fully shaped

and ready to pack. If the 25 le is short of length, proceed to the 25/.08 F2 and, when necessary, the 30/.09
F3, gauging after each Finisher with the appropriately
sized hand les (Figs. 19.29 A, B). If the 30 le is loose at length, then an alternative NiTi rotary le line or
manual les may be utilized to nish the apical extent of these larger, easier and more straightforward
canals.
In the instance of a longer, smaller diameter, and a
more curved canal, generally only three ProTaper instruments are required to produce a cleaned, tapered

canal that exhibits shape over length. Regrettably, there are ongoing debates regarding the extent of apical enlargement. It is needless to over-prepare the foramen if we understand and fully appreciate the relationship between apical le size and apical one-third
taper.1 In fact, it has been shown that irrigating with
EDTA, followed by NaOCl, can produce clean dentinal surfaces that are free of debris on uninstrumented
surfaces of root canals.2 ProTaper shapes are easy to
ll utilizing a ProTaper matching gutta percha obturator or master cone in conjunction with a warm vertical
condensation technique (Figs. 19.30 A, B).

B
Fig. 19.29. A. Following the use of the 25/.08 F2 rotary le to length, the foramen is gauged using a 25/.02 hand le. B. Following the use of the 30/.09 F3 rotary le, the foramen is gauged using a 30/.02 hand le.

B
Fig. 19.30. A. A three-dimensionally packed maxillary second molar demonstrates the smooth owing, uniformly tapered shapes that ProTaper les consistently create (Courtesy of Prof. Elio Berutti; Torino, Italy). B. The canals of this mandibular molar were shaped with ProTaper les. The three-dimensional pack
demonstrates owing shapes, apical one-third curvatures and multiple portals of exit (Courtesy of Dr. Jason West; Tacoma, Washington).

19 - The ProTaper Technique

Finishing larger systems

In instances where the foramen is gauged and determined to be greater than 0.30 mm, and a smooth
glide path has been veried, then an alternative NiTi
rotary le line may be used. The decision as to which
specic line of instruments to select should be based
on cutting efciency, exibility and safety. Importantly
the instruments chosen and the techniques employed
must create deep shape and the resistance form to
hold lling materials during three-dimensional obturation (Fig. 19.31).
Research evaluating canal cleanliness compared to
apical one-third shape has clearly shown that preparations need to taper greater than 0.06 mm/mm to ensure that a sufcient volume of irrigant over an adequate interval of time can efcaciously circulate, penetrate, and promote deep lateral cleaning.4,15,19 Except
in larger and straighter canals, rotary les that have
D0 diameters greater than 0.30 mm and tapers greater than 6% are frequently too stiff to safely place into the apical one-third of a more curved root canal.
As such, NiTi 0.04 or 0.06 tapered rotary les, like
ProFiles (Dentsply Maillefer; Ballaigues, Switzerland)
will provide the exibility to safely shape the apical
extent of these larger, more open canals. As noted

561

with hand les, NiTi rotary les can be employed in

a step-back technique to create virtually any tapered
shape that is desired.
Expanding the deep shape
There are cases when a ProTaper 20/.07 Finishing
le is snug at length, the foramen is conrmed to be
0.20 mm after gauging with a 20/.02 hand le, yet the
clinician may nd it advantageous to expand the deep
shape of the canal. In the instance where the F1 was
at length, then a fuller shape can be easily and safely
accomplished by carrying the F2 1.0 mm short and the
F3, 2.0 mm short of the working length.
This clinical method of carrying each larger
ProTaper Finishing le progressively shorter than
the previous one will maintain the size of the foramen while expanding the overall shape in the middle and apical one-thirds of the canal.10 This step-back
method is not done routinely and is only appropriate when different, well-angulated radiographs conrm that the dimensions of a root can safely accommodate a fuller shape.
Evidence for clinical success

Fig. 19.31. An endodontically treated maxillary central incisor demonstrates that a shaped canal provides resistance form to achieve three-dimensional
obturation.

A clinical investigation of the ProTaper technique,

emphasizing method of use, was conducted on mesial
canals of extracted mandibular molar teeth using CTAnalysis.19 In this particular study, horizontal sections
from different radicular levels were analyzed using
CT slices and volume renderings. The green color represented the anatomical contours before instrumentation whereas the red color indicated the shape after
instrumentation.
The results from this investigation are clinically relevant and a portion of the data is available for review
in Figs. 19.32 A-D.
The advantages of the Shaping les to brush laterally and selectively cut dentin on the outstroke are summarized below:
1) The Shaping les were essentially loose within a
canal during the majority of their work.
2) The coronal aspects of the canals were safely relocated away from an external root concavity.
3) A brush-cutting action achieved a centered preparation and maximized remaining dentin.
4) The Shaping les physically contacted over 90% of
the internal walls of the canals.